A retrospective study of the clinical benefit from acetylsalicylic acid desensitization in patients with nasal polyposis and asthma

Abstract

BackgroundAspirin-exacerbated respiratory disease (AERD), also known as Samter’s triad, is a clinical syndrome which consists of aspirin (ASA) intolerance, chronic rhinosinusitis with nasal polyposis, and intrinsic bronchial asthma (Press Med 119:48-51, 1922). ASA challenge is the gold standard for diagnosing AERD (Curr Allergy Asthma 9:155-163, 2009). The practice of ASA challenge and desensitization in Canada is infrequently utilized, which may explain its omission as a viable therapeutic option in the latest Canadian clinical practice guidelines for acute and chronic rhinosinusitis (AACI 7:1-38, 2011).MethodsThis retrospective study assessed 111 patients who underwent ASA desensitization in the Allergy and Immunology clinic at St. Joseph’s Healthcare (SJHC) in London, Ontario. The mean age was 50.7 years, and 52.5% (n = 58) were male. Sixty-one percent (n = 68) claimed prior, significant reactions to ASA, and all patients had features of AERD.ResultsSeventy-three percent (n = 81) claimed symptom improvement after achieving maintenance dosing on the desensitization protocol. Of this population, 21.6% (n = 24) improved in all 3 areas of interest (sense of taste or smell, upper respiratory symptoms and lower respiratory symptoms). Twenty-six percent (n = 29) had adverse effects, mostly in the way of gastrointestinal upset, but no severe adverse events were seen.ConclusionsASA desensitization helps improve symptoms in patients with AERD. Further, it allows patients to tolerate additional ASA and other non-steroidal anti-inflammatories (NSAIDs) when needed for supplemental analgesia or for cardio-protection. This is of particular benefit in those who require these medications for improved quality of life, and for reduced morbidity and mortality, such as those with cardiovascular disease or chronic pain. There should be further studies conducted in Canada as well as consideration for ASA desensitization to be included in the next clinical practice guidelines.

Impaired eating‐related quality of life in chronic rhinosinusitis

“…showed normalization of olfaction to that of the level of non‐AERD CRS patients as well as improvement of sinonasal symptoms (SNOT‐22 scores) following aspirin desensitization. Additionally, several reports have demonstrated improved QOL in AERD patients following aspirin desensitization, suggesting that this therapy could also potentially impact eating‐related QOL …”

A novel treatment adjunct for aspirin exacerbated respiratory disease: the low‐salicylate diet: a multicenter randomized control crossover trial

“…Systemic steroids can be very beneficial in the short term, but may have significant long‐term and short‐term side effects limiting their use. ASA desensitization has been shown to be beneficial for many AERD patients . Previous work has, however, shown that up to 30% of patients report having adverse gastrointestinal side effects secondary to ASA desensitization .…”

Aspirin Desensitization Treatment for the Management of Aspirin-Exacerbated Respiratory Disease

“…Other studies have shown the efficiency of AD treatment for control of both upper and lower airway disease [19,[23][24][25][26][27][28][29][30][31][32] . In the study by Stevenson et al [23] , 65 AERD patients were treated with a mean aspirin dose of 1,214 mg/day for a mean duration of 3.1 years.…”

“…A wide of aspirin dosages (100-1,300 mg/day) were used for the purpose of AD in these studies. There was varying degree of clinical benefit obtained from AD in different studies; some showing benefit for only control of upper airway disease [8,[20][21][22] and some for both upper and lower airway disease [19,[23][24][25][26][27][28][29][30][31][32] . To our knowledge, in only one study, which was carried out on 10 aspirin sensitive asthma patients by using 500 mg aspirin, AD was found ineffective as measured as an improvement on pulmonary function tests and reduced need for systemic corticosteroids [33] .…”

“…Many studies have shown that AD followed by daily aspirin treatment was associated with an improved clinical course in patients with AERD [8,[19][20][21][22][23][24][25][26][27][28][29][30][31][32] . A wide of aspirin dosages (100-1,300 mg/day) were used for the purpose of AD in these studies.…”